JACEP
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The Emergency Medicine Core Content represents the central body of knowledge of emergency medicine and is presented as an itemized list of clinical diseases, major clinical symptoms, administrative entities, and physician skills. It comprises the nucleus of the actual practice of clinical emergency medicine. Finally, it describes the educational scope of postgraduate training and continuing medical education in emergency medicine. ⋯ All diseases and symptoms were included on the basis of four criteria: conditions which pose immediate life or limb threat; conditions which potentially require inhospital treatment; conditions which give rise to significant discomfort to the patient and conditions with medicolegal implications. The Emergency Medicine Core Content has been widely circulated and has input from numerous individuals and committees. All critiques were closely reviewed and employed to derive the final document as it now exists.
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Intense cyanosis in a previously well, 30-month-old, white girl was found to be due to the ingestion of benzocaine. A wide variety of chemical compounds present in many proprietary products, when ingested, can cause this presentation in individuals with structurally normal hemoglobin and normal activity of methemoglobin reductase. ⋯ Immediate recognition and initiation of appropriate therapy will effect a rapid reversal of the methemoglobinemia, and in some cases, may be life-saving. Caution should be exercised in the use of benzocaine-containing preparations.
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Case Reports
Echocardiographic incidence of pericardial effusion in patients resuscitated by emergency medical technicians.
The incidence of echocardiographically determined pericardial effusion was assessed in the early postmanual cardiopulmonary resuscitation (CPR) period in a group of patients resuscitated by advanced emergency medical technicians (EMT-P) from the Rescue Division of the Tampa Fire Department. The survival rate from out-of-hospital sudden death is comparable to that reported in other series. Twenty-six survivors of out-of-hospital sudden death had echocardiograms performed an average of 2.5 days (range 0-10) postCPR to determine the amount of pericardial effusion. ⋯ One had received intracardiac drugs, but the pericardial effusion could be explained by congestive cardiomyopathy. Another had congestive cardiomyopathy, and the third had sustained a severe steering wheel injury to the chest. Thus, manual CPR with or without the use of intracardiac drugs does not appear to cause significant pericardial effusions in survivors of sudden cardiac death.
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A case of alcoholic ketoacidosis in a 23-year-old chronic alcoholic, gravada V, para IV, is reported. Symptoms were constant, severe, nonradiating pain with crampy exacerbations, anorexia, nausea and vomiting. The patient had a tender and irritable full-term uterus. ⋯ Metabolic derangements combine to produce ketoacidosis more readily in the pregnant alcoholic. Differentiation of alcoholic ketoacidosis and diabetic ketoacidosis is important since treatment varies. For alcoholic ketoacidosis, treatment is vigorous rehydration with dextrose-saline while diabetic ketoacidosis usually requires multiple therapeutic modalities.
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A case of accidental shock to the head, caused by a cardiac defibrillator, is presented. The shock resulted in minor burns and symptoms similar to those of postelectro-convulsive shock therapy (ECT). ⋯ An assumption that the demonstration equipment was not real seems to have been the cause of the accident. Suggestions for prevention of further episodes are discussed.